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Review Corneal Disorders Keratoconus Screening in Primary Eye Care – A General Overview Sara Ortiz-Toquero 1,2 and Raul Martin 1,2,3 1. Optometry Research Group, IOBA Eye Institute, School of Optometry, University of Valladolid, Valladolid, Spain; 2. Universidad de Valladolid, Departamento de Física Teórica, Atómica y Óptica, Valladolid, Spain; 3. School of Health Professions, Plymouth University, Plymouth, UK K eratoconus early detection (screening) and diagnosis requires an in-deep corneal analysis with different techniques; slip lamp assessment, corneal topography and corneal tomography are the most commonly accepted to detect clinical signs and assess anterior and posterior corneal surface and global corneal pachymetry. However, keratoconus early detection and definitive diagnosis are two different clinical procedures that require a different approach and goals. The aim of this review is to provide some general information about different corneal assessment technology, useful in keratoconus patient assessment; highlighting the differences in the adequate investigation techniques to its detection in primary eye care clinic and to conduct the definitive diagnosis (usually in a cornea specialist clinic). Information of most extensively available commercial devices and the advantages and disadvantages of their use in keratoconus early detection and diagnosis are described. In conclusion, corneal topography (Placido-based keratographers) plays a significant role in keratoconus detection, especially in primary eye care clinics. However, corneal tomography (with different slit scanning and/or rotational imaging devices) including posterior corneal surface assessment and global corneal pachymetry investigation, is critical in definitive keratoconus diagnosis. Keywords Keratoconus, early detection, screening, corneal topography, corneal tomography, primary eye care Disclosure: Sara Ortiz-Toquero was supported by Junta Castilla y León (Consejeria de Educación), Program, Estrategia Regional de Investigación Científica, Desarrollo Tecnológico e Innovación 2007-2013, co-funding by Social European Fund. Raul Martin has nothing to disclose is relation to this article. No funding has been received for the publication of this article. This study involves a review of the literature and did not involve any studies with human or animal subjects performed by any of the authors. Acknowledgements: The authors would like to thank Mr Gonzalo Velarde Rodriguez, (Clinilaser, Madrid, Spain), Dr Victoria de Juan (Hospital Ramon y Cajal, Madrid, Spain) and Mrs Guadalupe Rodriguez Zarzuelo (IOBA Eye Institute, University of Valladolid, Valladolid, Spain) for their collaboration in this manuscript preparation. Authorship: All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship of this manuscript, take responsibility for the integrity of the work as a whole, and have given final approval to the version to be published. Open Access: This article is published under the Creative Commons Attribution Noncommercial License, which permits any non-commercial use, distribution, adaptation and reproduction provided the original author(s) and source are given appropriate credit. Keratoconus early detection (screening) and diagnosis requires an in-deep corneal analysis with different techniques available. 1 Slip lamp assessment and corneal topography/tomography are the most commonly accepted techniques in eye examination. Corneal topography and corneal tomography are useful terms that distinguish between two different types of corneal examination, so both will coexist and be complementary. 2 In fact, hybrid systems, combining Placido disk-based videokeratography and slit-scan images provide reliable corneal measurements in keratoconus assessment. 3,4 The aim of this review is to provide general information about different corneal assessment technologies useful in keratoconus assessment; highlighting the different investigative techniques from its detection in the primary eye care clinic to definitive diagnosis, usually in the cornea specialist clinic. Information of most extensively available commercial devices, and the advantages and disadvantages of their use in keratoconus early detection and diagnosis, are described. Method of literature search We performed an extensive electronic search of the Medline and PubMed databases using individual and combinations of key words (keratoconus, keratoconus fustre, subclinical keratoconus, keratoconus treatment, keratoconus topography, keratoconus tomography, scheimpflug, keratoconus biomechanical properties and keratoconus anterior OCT) in May 2016 to identify the relevant publications in this field. We included the references if they focused on assessment techniques of the cornea in keratoconus patients. We excluded techniques that are considered experimental, non-English publications and case reports. Received: 28 September 2016 Accepted: 11 Novermber 2016 Citation: European Ophthalmic Review, 2016;10(2):80–5 Corresponding Author: Raul Martin, IOBA Eye Institute, University of Valladolid, Campus Miguel Delibes, 47011, Valladolid, Spain. Faculty of Health and Human Sciences, Plymouth University, Derriford Road, Plymouth, PL6 8BH, UK; E: 80 Keratoconus Keratoconus is a multifactorial disease with genetic, biochemical, biomechanical, and environmental pathophysiology, 5 characterised by a thinning and steepening of the central and paracentral cornea, affecting approximately 1/2000 people in the general population. 6–8 Commonly, this bilateral and asymmetric ectatic condition appears during the second decade of life and puberty and it progresses until the fourth decade of life, causing high myopia and irregular astigmatism. 5–8 Keratoconus patient management requires a multi-professional approach for early detection, correct diagnosis, follow up, monitoring and adequate management that involve: primary eye care practitioners, optometrists, contact lens (CL) practitioners and ophthalmologists with the last aim to provide better care and improve patients’ quality of life. 9,10 TOU C H ME D ICA L ME D IA